Transcript Pediatric Mental Health - Idaho School Counselors

PEDIATRIC MENTAL
HEALTH
Ages 4-12
VIDEO CLIP
Camp Erin
HUMAN DEVELOPMENT(2)

Erik Erikson
Trust vs. Mistrust
 Autonomy vs. shame
 Initiative vs. guilt
 Industry vs. inferiority

BRAIN AND BEHAVIOR
PSYCHOSOCIAL SCIENCES
Attachment Theory
 Learning Theory
 Classical conditioning
 Operant conditioning
 Cognitive Learning Theory
 Social Learning Theory

MULTIAXIAL ASSESSMENT
Axis I:
 Axis II:

Axis III:
 Axis IV:
 Axis V:

Clinical Disorders
Personality Disorders/
Mental Retardation
General Medical Issues
Psychosocial Stressors
Global Assessment of
Functioning
MULTIAXIAL ASSESSMENT

Axis I:
Axis II:
 Axis III:
 Axis IV:
 Axis V:

Depressive Disorder NOS
Generalized Anxiety Disorder
MMR (PD dx > age 18)
Asthma, Otitis media
Victim of child abuse
GAF=62
PERVASIVE DEVELOPMENTAL D/O’S
Autistic Disorder
 Aspergers Disorder
 Pervasive Developmental Disorder, NOS

AUTISTIC DISORDER(1)

(A) Social Impairment Marked impairment nonverbally
Underdevelopment of Peer relations
 Lack of sharing enjoyment, markedly limited
interests
 Lack of social or emotional reciprocity

AUTISTIC DISORDER (2)

(B) Impairment in Communication AEB
Underdevelopment of language
 Limited abilities in initiating or sustaining
conversations
 Idiosyncratic or repetitive language patterns
 Lack of make believe play or social imitative play

AUTISTIC DISORDER (3)

(C) Restricted, repetitive patterns of bx, interest
and activities AEB
Unusual Preoccupation in an area of interest
 Adherence to routines or rituals
 Repetitive motor mannerisms
 Persistent preoccupation with parts of objects

ASPERGERS DISORDER (1)

(A) Social Impairment Marked impairment nonverbally
Underdevelopment of Peer relations
 Lack of sharing enjoyment, markedly limited
interests
 Lack of social or emotional reciprocity

ASPERGERS DISORDER (2)

(B) Restricted, repetitive patterns of bx, interest
and activities AEB
Unusual Preoccupation in an area of interest
 Adherence to routines or rituals
 Repetitive motor mannerisms
 Persistent preoccupation with parts of objects

ASPERGERS DISORDER(3)
 (C)
Disturbance causes clinically
significant impairment in social,
occupational or other area of functioning.
 (D) No clinically significant delay in
language
 (E) No clinically significant delay in
cognitive development or in the
development of age-appropriate self held
skills, adaptive behavior and curiosity
about the environment.
PERVASIVE DEVELOPMENTAL D/O
Severe and pervasive in the development of social
interactions associated with impairment in
verbal or NV communication skills or with the
presence of stereotyped bx, interests, and
activities.
 Does not meet criteria for Autism or Aspergers.

ADHD

Subtypes
Predominantly Inattentive Type
 Predominantly Hyperactive-Impulsive Type
 Combined Type
 Not Otherwise Specified

ADHD INATTENTIVE
6
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


or more symptoms for at least 6 months
Fails to give close attention to details/makes
careless mistakes
Difficulty sustaining attention tasks/play
Does not listen when spoken to directly
Poor follow through on chores, duties, etc.
Has difficulty organizing
Avoids tasks that require mental effort
Frequently loses items
Easily distracted
Forgetful of daily activities
ADHD HYPERATIVE/IMPULSIVE
6
or more for at least 6 months
Fidgets with hands or squirms in seat
 Leaves activities when expected to stay
 excessively motor active when inappropriate
 Has difficulty with leisure activities/being
quiet
 “driven by motor” or often “on the go”
 Talks excessively
 Blurts out answers
 Trouble waiting for turn
 Often interrupts or intrudes on others

ADHD
At least some of the symptoms were obvious
before the age of 7
 Impairment is seeing in two or more settings
 Impairment must be clinically significant in
social, occupational or academic setting

ADHD NOS

Symptoms of ADHD are prominent but do not
meet the criteria for Combined type, Inattentive
type
ADHD HISTORICAL TIMELINE
Minimal Brain Damage
1920’s
Minimal Brain Dysfunction
1930’s
Efficacy of Amphetamine
1937
Hyperactive Child Syndrome
1950
Hyperkinetic Reaction of Childhood (DSM-II)
1968
ADD or Hyperactivity (DSM-III)
1980
ADHD (DSM-III)
1987
ADHD (DSM-IV)
1994
ADHD FACTS
Prevalence 10 % of school children
(2% female 8% male)
 Most commonly diagnosed behavior disorder of
children ages 6 - 12 years old in North America

ADHD RATING SCALES

Elementary School
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Child Behavioral Checklist (CBCL)- Parent, Teacher,
or Youth Forms
Conners Parent and Child Rating scales (CPRS and
CTRS)
SNAP (Swanson, 1988)
Vanderbilt AD/HD Diagnostic Rating Scales
VIDEO CLIP


http://www.pbs.org/wgbh/pages/frontline/shows/m
edicating/watch/
Robins Story
DISRUPTIVE BEHAVIOR DISORDERS
Conduct Disorder
 Oppositional Defiant Disorder
 Disruptive Behavior D/O NOS

CONDUCT DISORDER(1)

Aggression to People/Animals
-
Bullies, threatens or intimidates
Initiates physical fights
Used weapon that can cause harm
Physically cruel to people/animals
Has stolen w/o confronting victim
Forced sexual activity
CONDUCT DISORDER(2)

Destruction to Property
Deliberate fire setting behavior
 Deliberate destruction of property

CONDUCT DISORDER(3)

Deceitfulness or theft
Breaking into homes/cars
 Lies to obtain goods or favors or to avoid obligations
 Stolen items of nontrivial nature w/o confronting a
victim

CONDUCT DISORDER(4)

Serious violations of rules
Stays out later than approved by parents
 Has run away from home two times
 Truant from school, beginning before age 13

CONDUCT DISORDER(5)
Behavior causes clinically significant
impairment in functioning
 If > age 18 criteria not met for Antisocial
personality disorder

CONDUCT DISORDER(6)
Childhood onset (sxs present prior to age 10)
 Adolescent onset (sxs absent prior to age 10)

OPPOSITIONAL DEFIANT D/O

Pattern of negative and hostile bxs for atleast 6
months (4+)
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Loses temper
Argumentative with adults
Defies rules
Deliberately annoys people
Blames others for his/her mistakes
Touchy or easily annoyed
Angry and resentful
Spiteful and vindictive
DISRUPTIVE BX D/O

Clinically significant impairment that does not
meet criteria for ODD or CD.
TIC DISORDERS
Tourrette’s Disorder
 Chronic Motor of vocal Tic Disorder
 Transient Tic Disorder
 Tic Disorder, NOS

TOURETTES DISORDER
Multiple motor and 1 + vocal tics
 Tics occur throughout day, nearly every day for 1
year
 Tic causes marked distress/impairment
 Onset before age 18

OTHER TIC DISORDERS
 Chronic
motor tic disorder: one or more
motor tics for greater than one year
 Chronic vocal tic disorder: one or more
vocal tics for greater than one year
 Transient tic disorder: one or more tics for
greater than 4 weeks but less than 12
months
 Tic disorder NOS (not other wise
specified)
MOOD DISORDERS
Bipolar Disorder
 Major Depressive Disorder
 Dysthymic Disorder

BIPOLAR DISORDER

4 of 7
Inflated self-esteem or grandiosity
Decreased need for sleep
Increased talkativeness or pressure
Racing thoughts or flight of ideas
Distractibility
Increased activity or psychomotor agitation
Excessive involvement in consequential bxs.

Symptoms must last for one week
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BP VS ADHD
Mania Item
Bipolar
ADHD
Irritable Mood
97%
72%
Grandiosity
85%
7%
Elevated Mood
87%
55%
Daredevil Acts
70%
13%
Uninhibited People Seeking
68%
21%
Silliness/Laughing
65%
21%
Flight of Ideas
6%
10%
Accelerated Speech
97%
78%
Hypersexuality
45%
8%
VIDEO CLIP

http://www.pbs.org/wgbh/pages/frontline/parents/

The Medicated Child
Debate over Bipolar
 Jessica’s Story

MAJOR DEPRESSION
 Depressed
 Anhedonia
 Sleep
or irritable mood
difficulties
 Weight or appetite change
 Decreased concentration
 Thoughts of suicide or death
 Psychomotor agitation or retardation
 Fatigue or loss of energy
 Feelings of worthlessness/guilt
DYSTHYMIC DISORDER
Appetite change
 Sleep change
 Decreased energy
 Low self esteem
 Difficulty making decisions
 Feelings of hopelessness

ANXIETY DISORDERS
Separation Anxiety Disorder
 Generalized Anxiety Disorder (overanxious d/o)
 Reactive Attachment Disorder
 Specific Phobia
 Social Phobia
 Post Traumatic Stress Disorder

PREVALENCE OF
PEDIATRIC ANXIETY
DISORDERS
Anxiety Disorder
Children
Adolescents
Separation Anxiety Disorder
3.5 – 4.7%
0.7 – 2.0%
Generalized Anxiety Disorder
2.9 – 4.6%
5.9 – 7.3%
Social Phobia/Avoidant
0.9 –1.6%
1.1%
Specific Phobia
2.4 – 9.2%
3.6 – 4.6%
Panic Disorder
<1%
0.6 – 4.7%
SYMPTOMS OF ANXIETY
Cardiovascular
 Respiratory
 Skin
 Musculoskeletal
 Gastrointestinal
 Other physical
 Psychological
 Social/Behavioral

Palpitation, ^bp
 SOB, ^ respiration
 Flushing, sweaty
 Temors, cramps
 Diarrhea, nausea
 HA, chest pain
 Fears, stress
 Clingy,

SEPARATION ANXIETY DISORDER
Excessive distress during separation
 Persistent worry about harm, loss
 Forecasting of harmful events
 Reluctance to go places w/o parent/other
 Fear of being alone w/o parent/other
 Reluctance to go to sleep w/o parent/other
 Nightmare of separation themes
 Somatic complaints

GENERALIZED ANXIETY DISORDER
Excessive anxiety (X 6 months)
 Restlessness or feeling keyed up
 Easily fatigued
 Trouble concentrating
 Irritability
 Muscle tension
 Sleep disturbance

REACTIVE ATTACHMENT DISORDER

Developmentally inappropriate relatedness prior
to age 5 AEB
Failure to initiate or respond appropriately to social
interactions/relationships (inhibited subtype)
 Indiscriminate sociability with attachment
figures/strangers (disinhibited subtype)

SPECIFIC PHOBIA
Persistent fear that is excessive or unreasonable
 Cued by specific object or situation
 Results in anxiety response
 Avoidance leads to impairment of routine
 > than 6 months in duration for
minors

COMMON PHOBIAS IN CHILDREN
Animals
 Blood
 Thunder
 Dark
 Strangers
 Fire
 Germs/dirt
 Heights
 Spiders

Zoophobia
 Hematophobia
 Brontophobia
 Nyctophobia
 Xenophobia
 Pyrophobia
 Mysophobia
 Acrophobia
 Arachnophobia

SOCIAL PHOBIA/ANXIETY
Fear of performance
 Fear of unfamiliar people/situations
 Afraid of scrutiny
 Forecasts embarrassment
 Situations are avoided
 Children will express with tantrums/tearfulness,
freezing or
shrinking

PTSD IN VERY YOUNG CHILDREN

Journal AACAP October 1998
Very young children may present with few PTSD
symptoms. This may be because eight of the PTSD
symptoms require a verbal description of one's feelings and
experiences. Instead, young children may report more
generalized fears such as stranger or separation anxiety,
avoidance of situations that may or may not be related to
the trauma, sleep disturbances, and a preoccupation with
words or symbols that may or may not be related to the
trauma. These children may also display posttraumatic
play in which they repeat themes of the trauma. In
addition, children may lose an acquired developmental skill
(such as toilet training) as a result of experiencing a
traumatic event.
POST TRAUMATIC STRESS
DISORDER (1)
 Re-experiencing
the traumatic event
Nightmares/flashbacks/distressing memories
 Repetitive play with event related themes
 Sudden “catastrophic” anxiety with cues
 Sense of reliving event (trauma reenactement)
 Intense physiological/psychological distress
with similar events

POST TRAUMATIC STRESS
DISORDER (2)
 Avoidance
or emotional numbness
Efforts to avoid thoughts/feelings
 Efforts to avoid activities/places
 Limited recall of aspects of trauma
 Diminished interest in activities
 Feelings of estrangement/detachment
 Restricted affect
 Sense of foreshortened future

POST TRAUMATIC STRESS
DISORDER (3)

Increased symptoms of arousal
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Difficulty with sleep
Irritability/anger outburst
Poor concentration
Hypervigilance
Exaggerated startle response
POST TRAUMATIC STRESS
DISORDER (4)
Symptoms present for more than one month
 Symptoms cause impairment of functioning

PTSD IN MINORS
14-43% of boys/girls have experienced at least
one traumatic event in their life
 3 to 15% of girls and 1 to 6% of boys could be
diagnosed with PTSD.

ADJUSTMENT DISORDERS(1)
Onset of sxs related to stressor
 Either

Marked distress (more than typical)
 Significant impairment in identified domain.

ADJUSTMENT DISORDER(2)
Cannot be related to bereavement
 Acute-less than 6 months in duration
 Chronic-more than 6 months in duration

ADJUSTMENT DISORDER(3)

Subtypes
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w/ depressed mood
w/ anxiety
w/ anxiety and depression
w/ disturbance of conduct
w/ mixed emotions and conduct
unspecified